Healthcare Provider Details

I. General information

NPI: 1659254324
Provider Name (Legal Business Name): RIVERWALK MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E LAS OLAS BLVD STE 1301
FT LAUDERDALE FL
33301-2296
US

IV. Provider business mailing address

515 E LAS OLAS BLVD STE 1301
FT LAUDERDALE FL
33301-2296
US

V. Phone/Fax

Practice location:
  • Phone: 954-852-2125
  • Fax: 954-852-2126
Mailing address:
  • Phone: 954-852-2125
  • Fax: 954-852-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW PARDO
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-852-2125